TYPE 2 DIABETES MELLITUS

A Case Analysis in Committee of the

College of Nursing and School of Midwifery

City University of Pasay

Pasadeňa St. F.B Harrison Pasay City

In partial fulfillment of the requirements in

NCM 114 Related Learning Experience

By:

EVORA, SICHEM D.
 TABLE OF
CONTENTS

Introduction ……………………………………………….……3

I. Patient’s Profile…………………………………………….5-6
A. Demographic Profile

II. Background ……………………………………………7-11

A. Medical History
B. Physical Examination/Review of System
C. Pathophysiology

III. Alternative to the Problems……………………………...…...12

IV. Proposed Solutions……….…………………………………….13-14
V. Recommendation …………………………………………………15

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INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a chronic disorder characterized by elevated blood

glucose. People who are middle-aged or older are most likely to get this kind of diabetes. It
used to be called adult-onset diabetes. But type 2 diabetes also affects kids and teens, mainly
because of childhood obesity. Long-term effects of chronic uncontrolled blood sugar may
involve small and large vessels that may lead to complications such as blindness, renal
failure, neuropathy, amputation, stroke, and myocardial infarction.
The symptoms of type 2 diabetes can be so mild that you don't notice them. About 8 million
people who have it don't know it. Symptoms include:
 Being very thirsty
 Peeing a lot
 Blurry vision
 Being cranky
 Tingling or numbness in your hands or feet
 Fatigue/feeling worn out
 Wounds that don't heal
 Yeast infections that keep coming back
 Feeling hungry
 Weight loss without trying
 Getting more infections

About 6.7% of Filipinos are affected, and the numbers are growing. The daily lives of persons
with diabetes have been occupied with multiple self-care behaviors such as balancing diet,
physical activity, self-monitoring of blood sugar (SMBG), and adhering to medications like oral
hypoglycemic agents (OHA) and insulin to target optimum glycemic control. However, hidden
negative emotions may burden the everyday demands of self-managing a lifelong disorder
like diabetes.

Type 2 diabetes affects many major organs, including your heart, blood vessels, nerves, eyes,
and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious
chronic diseases.

You may be able to manage your diabetes with healthy eating and being active, or your
doctor may prescribe insulin, other injectable medications, or oral diabetes medicines to help
manage your blood sugar and avoid complications. You’ll still need to eat healthy and be
active if you take insulin or other medicines. It’s also important to keep your blood pressure
and cholesterol close to the targets your doctor sets for you and get necessary screening
tests.

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You’ll need to check your blood
sugar regularly. Ask your
doctor how often you should check it and what your target blood sugar levels should be.
Keeping your blood sugar levels as close to target as possible will help you prevent or delay
diabetes-related complications.

AT RISK

The risk of type 2 diabetes mellitus increases as you get older, especially
over age 45. Children, teenagers, and younger adults can get type 2 diabetes,
but it is more common in middle-aged and older people, especially at the age of
73

OBJECTIVES:

The main objective of this Case Analysis is to gain and develop knowledge regarding

Type 2 Diabetes Mellitus (T2DM) in adults by obtaining sufficient information which could

serve as a guide for future reference and to help the patient with her needs with enhanced

Nursing interventions and Evidence-based practice.

Specific Objectives:

At the end of this study, I will be able to:

COGNITIVE

1. Enhance the knowledge of nursing students regarding Disease

2. Interpret the data collected from the patient and the patient’s significant other.

3. To recognize the effect of the drugs administered on the patient.

4. Formulate an effective nursing care plan.

PSYCHOMOTOR

1. Gather reliable information about the patient’s condition through a thorough assessment.

2. Provide curative interventions through health teachings.

3. Establish a specific and appropriate nursing care plan.

AFFECTIVE:

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1. To build and establish

rapport among the patient and their significant others

2. To improve moral and emotional support

I. Personal Data

Name: Mr. J.J

Address: Laspinas City
Age: 73 years old
Sex: Male
Civil Status: Married
Religion: Roman Catholic
Birthday: January 17, 1949
Birthplace: Nueva Ecija
Occupation: SSS Pensioner
Attending Physician: Ralph Reyes Delos Santos, MD
Chief Complaint: pain and numbness of hands and feet
Admitting Diagnosis: Type 2 Diabetes Mellitus
Final Diagnosis: Type 2 Diabetes Mellitus

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 Sociocultural History

A. LIFESTYLE

The patient currently lives within the subdivision in his own house. His house is up
and down, there are two comfort rooms one upstairs and one downstairs, two
bedrooms upstairs, and they even have a gate outside. He lives with his only son who
is married. All he always does is eat, watch tv, and sit outside their house. He sleeps
more often, especially whenever he is not doing anything inside their house. He is a
senior citizen and only relies on his meager pension for his needs while his son’s
income is only enough to sustain their daily needs and household expenditures. He is
distressed as to where extra income can be derived to cover such needed expenses.

He graduated from high school but was unable to continue college due to a lack of
finances. After high school, he worked as a janitor in one of the schools in Manila for
almost 4 years. He then worked as a security guard for almost 26 years. He married
Luz Tubayan sometime in 1975 through a civil wedding ceremony in Pasay. but he has
not been with his wife for a long time because, before the pandemic, his wife returned
to his province and never returned to him. So that he chose to stay with his son and
also take care of his only grandson whenever his son is at work.

PSYCHOLOGICAL DATA

He answers my questions quickly, he doesn't hesitate every time he answers my questions.

Immunization History

Name 1st 2nd 1st 2nd Booster

of Dos Dose Booster Booster
Vaccin e
e

Covid-19 5 / 5 / 21 6 / 2 / 21 12 / 3 / 21 5 / 25 / 22 Complete
Vaccine Sinovac Sinovac AstraZeneca Pfizer - Biotech
 BACKGROUND

Medical History

The patient has a history of Type 2 Diabetes Mellitus and still has to this day.

Mr. Jaime R. Jaime, whom I am using for my nursing case study is a 73-years-old brown male. He
weighs 74 kg, and his height is 5’4” tall. He is very active and has difficulty walking long distances and
he always complains about pain and numbness of his hands and feet. My patient has no work but SSS
pensioner. He has diagnosed case of Type 2 Diabetes Mellitus 8 months ago in Public General Hospital
in Laspinas. His medications were Metformin 500g tab for type 2 diabetes taken 1 tablet 3x a day, and
Gliclazide 80mg tab for type 2 diabetes taken 1 tablet once a day. He has diagnosed case of Type 2
Diabetes Mellitus. He doesn't miss the right time to take his medicine, but when he doesn't have
enough money to buy his medicine, he doesn't take the medicine. he never misses going to the right
day of his follow-up checkup with the doctor. His vital signs appear normal in my notes except for his
blood sugar level which is 317 mg/dL from today.

Vital Signs Follows:

Temperature: 36.5 C
BP: 120/70
RR: 16 breaths per min
PR: 70 bpm
O2 SAT: 98%
Blood Sugar Level: 317 mg/dL

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 Physical
Examination / Review of System

Body Part Normal Findings Actual Findings Analysis /

Interpretation
General Inspection Inspection - Normal Findings
Appearance - Patient is well - Patient is well groomed
& Behavior groomed. and behaves according
- Patients behave to his age.
according to his
age.
Skin Inspection Inspection - Normal Findings for
- Uniform in color - Uniform in color (light elderly
- Normal Texture brown)
- No presence of - Wrinkle Texture
scar - No presence of scar

Head Inspection Inspection - Normal Findings

Proportional to the - Proportional to the size
size of the body of the body
round with - symmetrical and all
prominence in the planes
frontal are
anteriorly in the
occipital area
posteriorly
symmetrical in all
planes
Face Inspection Inspection - Normal Findings for
- Symmetrical or - Slight asymmetric elderly
slight asymmetric facial features;
facial feature; - wrinkle in forehead and
- free from wrinkle cheeks
and edema
Eyes Inspection Inspection - Normal Findings
- Rounded eyes - Round, symmetrical to
Symmetrical to each other
each other,

Eye Inspection Inspection - Abnormal findings

movement Able to move eyes Slow but able to move
in full range motion eyes in full range
Able to move in all motion, slightly blurred
direction without vision with a vision of
difficulty. 10/20. Able to move in
all directions without
difficulty.

Ear canal Inspection Inspection - Normal findings

Contain of few Few cilia, no presence
cilia, no presence of lesion, hearing ability
of lesion is clear.

Nose Inspection Inspection - Normal findings

Midline, Midline, symmetrical and
symmetrical and patent, uniform in color.
patent, uniform in
color.

Mouth Inspection Inspection -Normal findings

- Pinkish, - Pinkish and moist
symmetrical and - symmetrical
 moist

Teeth Inspection Inspection - Abnormal findings

22 adult teeth Yellowish teeth with the
Smooth and white, presence of plaque and
shiny tooth enamel dentures caries.
(-) plaque
(-) caries
(-) dentures
Gums Inspection Inspection - Normal Findings
Pinkish and moist Pinkish and moist, no
No swelling, no swelling or discharge.
discharge
Tongue Inspection Inspection - Normal findings
Central position, No presence of lesion,
pink color, no move freely, central
presence of lesion, position, pinkish in color.
move
Voice Inspection Inspection - Normal findings
No hoarseness Well-modulated and no
and well- hoarseness.
modulated.
Clavicle Inspection Inspection - Normal findings
Symmetrical in No presence of redness
position, no and lesion, symmetrical
presence of in position
redness and lesion
Axilla Inspection Inspection - Normal findings
- Presence of hair, - Moist, presence of
Skin is intact, no small hair, no odor, Skin
odor, skin area is darker,
uniform
Upper Inspection Inspection - Abnormal findings
extremities/ - Hands are - Hands are symmetrical
Arms symmetrical in size in size and length.
and length

Able to raise arms - Not able to raise arms

against resistance against resistance but
and bilateral equal bilateral equal to each
to each other other.
Abdomen Inspection Inspection - Normal Findings
- Skin is uniform in - Skin is intact, and
color uniform in color.
- Umbilicus is
(concave) - Umbilicus is (concave)
positioned midway
between the
epigastric and
xiphoid process.
Lower Able to raise leg - Not able to raise the - Abnormal findings
Extremities against resistance leg on the right and left
and bilateral equal leg against resistance
to each other but bilateral equal to
each other.

Pathophysiology

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 Individuals with Type 2 Diabetes Mellitus have detectable levels of
circulating insulin. The individuals with impaired glucose tolerance have hyperglycemia
in spite of having the highest levels of plasma insulin, indicating that they are resistant
to the action of insulin. In the progression from impaired glucose tolerance to diabetes
mellitus, the level of insulin declines indicating that patients with T2DM have decreased
insulin secretion. Insulin resistance and insulin deficiency are common in average T2DM
patients.

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 ALTERNATIVE TO THE PROBLEMS

During the assessment, I prioritized taking the patient’s blood sugar level first for the actual diagnosis.
The blood sugar of the patient is 317 mg/dL which is indicated as not normal for his age. I provided him
to do physical activities every day, avoid drinking alcohol, and eat healthy foods. I also remind him to
take his prescribed medication on time and then monitored his blood sugar level to drop less than 180
mg/dL two hours after eating.

And then proceed to the following Alternative to the problems:

1. Educate about healthy foods that are good for people that have T2DM and avoid high-fat meat, sweet
desserts, and sugar-sweetened beverages like juice, soda, etc.

2. Encourage to do exercise because it is good for adults, especially for does who have diabetes which
helps to increase insulin sensitivity, which helps the cells use any available insulin to take up glucose
from the blood.

3. Monitor him from time to time to know if his blood sugar level is high.

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 PROPOSED SOLUTION NCP – Actual

Assessmen Diagnosis Planning Intervention Evaluation

t
Subjective: Risk for prone Short Term Independent: Goal Met
“Bakit biglang behavior related After 30 mins of After 30 mins of nursing
sumasakit ang to lack of Nursing Educate the intervention, the patient will fully
mga braso at knowledge and intervention, the patient about the understand the causative factors
binti ko tapos treatment about patient will be importance of for type 2 diabetes mellitus.
mayamaya the disease. able to verbalize knowing the
nawawala din an negative side of Goal Met
naman tapos understanding having type 2 After 30 mins of nursing
babalik ulit?” of individual diabetes mellitus. intervention and health
as verbalized causative teachings, the patient will
by the factors Emphasize proper identify the importance of lifestyle
taking of healthy food changes to promote a safe and
patient.
After 30 mins of and physical activities healthy body.
Objective: Nursing every day.
- pain and intervention, the Goal Met
numbness of patient will be able Health teachings to After 2 hours of nursing
arm and leg to Identify the patient about intervention, the patient
-Lack of interventions of the high blood sugar understands the importance of
knowledge care in Type2 level, and encourage visiting a Physician and taking
-Curiosity diabetes mellitus the patient to on time properly prescribed by
undergo visiting his the physician.
VS: After 30 mins of doctor every time that
Nursing he has a follow-up
T: 36.5 C intervention, the check-up and take
BP: 120/70 patient will prescribed medication
RR: 16 bpm demonstrate his on time.

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PR: 70 bpm lifestyle changes
O2 SAT:
98% Long Term
Blood Sugar
Level: 317 After 2 hours of
mg/dL Nursing
intervention, the
patient will be able
to demonstrate the
importance of taking
medication and
visiting the doctor for
monitoring.

RECOMMENDATIONS

- Patient should visit the physician to monitor his condition.

- Patient should avoid high-fat meat, sweet desserts, and sugar-sweetened beverages like juice, soda, etc. that will
trigger his blood sugar level.

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.
- Patient should trust medical professionals to handle his situation.

- Taking his medication is the best treatment for his condition. I will make sure that he is well informed about the
benefits of taking proper medication.

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